Pubertal Hormones: Influence on Migraine in Girls

Increases in urine progesterone levels were more predictive of headache onset days than measures of estrogen.

Mechanisms involved in balancing reproductive hormones in girls may influence the patterns of migraine headache onset, according to a study recently published in Cephalgia.1 Headache patterns observed directly before and after puberty indicated correlations with greater variations in the urine levels of specific ovarian hormones.

For this pilot study, the investigators recruited 34 girls from the Cincinnati Children’s Headache Center from October 2011 to November 2012. The girls all met International Classification of Headache Disorder-II (ICHD-II) criteria for migraine with or without aura, or chronic migraine. The participants were stratified into 3 age groups: pre-pubescent (8 to 11 years; n = 12), pubescent (12 to 15 years; n = 11), and post-pubescent (16 to 17 years; n = 11). They all completed daily headache diaries and provided daily urine samples to track hormonal fluctuations.

A total of 1183 headaches were experienced on 3485 diary days, for a rate of 33.9%. The greatest headache frequency was in post-pubescent girls (40.6%), followed by pubescent girls (34.7), and pre-pubescent girls (24.8%). This significant difference in headache frequency (P <.001) was partially explained by the greater degree of hormonal fluctuations recorded in the older participants compared with the younger participants.

Urinary levels of pregnandiol glucuronide (PdG) corresponded with the number of headache onset days in all participants — although stage of puberty seemed to be a strong factor — after controlling for age and/or pubertal development scores (PDS). The probability of headache onset days in response to elevated progesterone increased in pre-pubescent girls and decreased in post-pubescent girls, with little effect in pubescent girls. The authors suggested that higher PdG levels at a younger age pointed to an increased risk for new onset headache before menarche. “There seems to be a graded effect to progesterone that is dependent on age,” they wrote.

The study found that increases in urine progesterone levels were more predictive of headache onset days than measures of estrogen, contrary to evidence pointing to declining estrogen during menstruation as the potential trigger for menstrual migraine attacks in adult women.2 This signified 2 main possibilities: 1) that the degree of estrogen decline in adolescence is not substantial enough to trigger a migraine attack, or 2) that the effect is cumulative over many years of repeated exposure to sudden declines of estrogen. It was also conceivable, the researchers acknowledged, that the sample size of the study was not large enough to detect a significant effect of estrogen in girls with migraine.

A univariate association between PdG and headache severity was detected, although the effect size was small, and was achieved on only 1 day in the entire cohort. The authors therefore concluded it was unlikely that ovarian hormones exert any significant effects on headache severity.

References

Martin VT, Allen JR, Houle TT, et al. Ovarian hormones, age and pubertal development and their association with days of headache onset in girls with migraine: an observational cohort study. Cephalgia 2017; Jan 1:333102417706980. doi: 10.1177/0333102417706980. [Epub ahead of print]

SomervilleThe role of estradiol withdrawal in the etiology of menstrual migraine. Neurology 1972;22:355–365.

Testimonials

“As Director of Surgical Services Departments there has been considerable changes have occurred in my department and Anesthesia Experts has always risen to meet our demands of our facility. They have been very pro-active in meeting the increase volumes allowing us to keep our surgeons and patients very satisfied with our services.”

AR BSN 346 beds AL

“Before AE took over the anesthesia department was described by the surgeons as the worst in the history of our hospital. The prior management company was having a cancelled surgery per day. I am happy to report there has not been one since they have taken over the department. Additionally we have seen a 905 reduction if requested preop
lab tests. The anesthesia department is now the very best hospital department in our entire facility.”

DS CEO 272 beds MS

“Anesthesia Experts has provided consistent anesthesia providers who display a high degree of integrity, responsibility and professionalism. They have become a more valuable part of our facility and community.”

LR CEO 150 beds TX

“Even though they are physically located 1000 miles away Anesthesia Experts just does not provide great anesthesia coverage they personally engage surgeons to increase their business. Last year my surgical volume rose by 24% and we are currently 50% ahead of last year and all of that growth is organic.”

JE FACHE CEO AL 92 bed hospital

“Anesthesia Experts is more responsive than anyone I have dealt with. They are available by phone whenever needed and will be on site for any need or request and has been on site to address issues before we can make the request.”

SW CEO 25 beds NM

“While problems are extremely rare when they do occur Anesthesia Experts quickly and professionally implements a solution. Our surgical volume has grown over 100 cases per month and now our GI docs want to perform all of their endoscopies in our hospital instead of their GI lab that they own!”

SP CEO 346 beds AL

“Our anesthesia department was a thorn in my side that kept me awake at night. Anesthesia Experts swept in and brought order to our mess and our department was quickly redirected.”